| Objective: By collecting in our line of carotid intima peeling technique(carotid endarterectomy,CEA)and carotid artery,carotid stenting(carotid artery stenting,CAS)patient information,according to the patients with postoperative recovery,comparative analysis of postoperative patients with short-term,medium-term curative effect,objectively evaluate CEA and CAS in the treatment of carotid stenosis of extracranial postoperative clinical curative effect analysis.Methods: This study analyzed retrospectively from January 2013 to October 2019 in our hospital CEA and CAS in the treatment of carotid stenosis of extracranial patients,with the help of telephone follow-up or outpatient follow-up patients to January 2020,the CEA in 132 cases,9 were lost to follow-up,the actual selected 123 cases,the CAS113 cases,7 cases were lost to follow-up,the actual selected 106 cases,a total of 229 patients were selected.All the patients underwent preoperative extracranial DSA,extracranial CT angiography(CTA),neck angiography,magnetic resonance angiography(MRA),and all the selected patients met the American heart association(AHA)and stroke association(ASA)surgical indications.The preoperative general conditions of the two groups of patients were collected and analyzed,including gender,age,basic diseases,smoking and drinking history,and carotid artery stenosis.The postoperative changes of patients in the two groups were collected and compared,including postoperative symptom changes,postoperative complications,hospital stay days,hospital expenses,etc.Results: There was no significant difference between CEA group and CAS group.CEA group have 5 patients had the husky,including 2 cases of patients with minor water choking cough,2 weeks after symptoms disappear,consider intraoperative excessive pull laryngeal recurrent nerve and the effect of endotracheal intubation,postoperative wound swelling in 2 patients,no difficulty breathing,resulting in a poor postoperative wound oppression caused by soft tissue edema,after half a month or so basic recovery,3 cases postoperatively in patients with coronary heart disease in acute myocardial infarction,5 cases with postoperative half year in cerebral infarction,including 1 patient had a large area of cerebral infarction,hemiplegia and aphasia,which was considered to be caused by plaque detachment,1 patient developed secondary carotid artery stenosis 10 months after the operation;considering the irregular oral medication after the operation,5 patients developed cerebral hyperperfusion syndrome after the operation,and no patients died.The average hospitalization days were 9.45±1.38 days,and the average hospitalization cost was(35749.45±10951.24)yuan.CAS group no voice hoarse,no water choking cough patients,the wound swelling,breathing difficulties,there are 7 cases of postoperative half year in cerebral infarction patients,among them 2 cases of patients with postoperative cerebral infarction,postoperative plaque off cause,there are 2 patients within 1 year after carotid artery restenosis,2 cases with excessive postoperative cerebral perfusion syndrome,1 case postoperatively in patients with coronary heart disease in acute myocardial infarction,no patients died.The average hospitalization days were 8.27±1.14 days,and the average hospitalization cost was(53188.26±17646.79)yuan.Comparative analysis of the two groups of postoperative complications CEA in local nerve damage,excessive local tissue damage,myocardial infarction,cerebral perfusion syndrome with CAS group,difference has statistical significance(P<0.05),the case fatality rate difference between the two groups,CEA group in postoperative patients with cerebral infarction and carotid artery restenosis of the carotid artery,CAS group,less statistically significant difference(P<0.05).There was a statistical difference in the average length of hospitalization between the two groups(P<0.05).Conclusion:Both surgical methods are safe and effective in the treatment of carotid stenosis.CEA can completely remove the plaque at the stenosis,and has a more effective treatment for carotid artery stenosis.It is mostly suitable for patients withrelatively light grade,generally good systemic conditions,no serious organ dysfunction,and able to withstand general anesthesia.CAS is suitable for patients with large grade,poor general condition,dysfunction of vital organs,and intolerance to general anesthesia.However,the incidence of cerebral infarction and carotid artery restenosis in patients after operation is more than that in CEA group,and the difference is statistically significant.Patients need long-term oral antiplatelet drugs after operation to prevent restenosis. |
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